[Knowledge assessment of the coding using CSARR nomenclature, two years after its establishment]. / Bilan de l'appropriation du CSARR, deux ans après sa mise en place.

BACKGROUND: French post-acute care and rehabilitation facilities describe and code their activity through the Program for Medicalization of Information Systems (PMSI). A new specific catalogue of rehabilitation procedures (CSARR) has been implemented to code rehabilitation acts since 2013. This study aimed to assess the coherence of the coding of the rehabilitation acts using the CSARR two years after its establishment through the analyze of 3 main items regarding patients and therapists. METHODS: We analyzed the use of CSARR for coding rehabilitation acts from the PMSI national database for post-acute care and rehabilitation, in 2015. Analyses were made on specific items characterizing rehabilitation acts: "number of patients", "type of therapists" and "number of therapists". RESULTS: There were 72,014,731 rehabilitation acts coded in 2015 using CSARR nomenclature; 86% were individual rehabilitation acts. All acts of CSARR, except one, were used to describe rehabilitation activities. Physiotherapists coded the majority of rehabilitation acts (47%), then nurses (14%). Coding errors were identified as the "number of patients", coded with more than one patient for individual acts (13% of the acts) or with less than 2 patients for groups (6% of the acts), or the "number of therapists" coded with only one therapist for rehabilitation acts requiring several professionals. CONCLUSION: This first assessment indicated a good level of appropriation of the CSARR coding rules in the national PMSI database by post-acute care and rehabilitation facilities. However, a simplification of this catalogue and therapist training could increase the quality of the rehabilitation data.

Economic burden and health-related quality of life associated with Prader-Willi syndrome in France.

BACKGROUND: To date, there has been no published comprehensive estimation of costs related to Prader-Willi syndrome (PWS). Our objective was therefore to provide data on the economic burden and health-related quality of life associated with PWS in France in order to raise awareness of the repercussions on individuals suffering from this syndrome and on caregivers as well as on the health and social care systems. METHOD: A retrospective cross-sectional study was carried out on 51 individuals recruited through the French PWS patient association. Data on their demographic characteristics and resource use were obtained from an online questionnaire, and costs were estimated by a bottom-up approach. The EQ-5D-5L health questionnaire was used to measure the health-related quality of life of individuals suffering from PWS and their caregivers. RESULTS: The average annual cost of PWS was estimated at €58 890 per individual, with direct healthcare accounting for €42 299, direct non-healthcare formal costs €13 865 and direct non-healthcare informal costs €8459. The main contributors to PWS costs were hospitalisations and social services. Indirect costs resulting from loss of productivity in the labour market was €32 542 for adults suffering from PWS. Mean EQ-5D utility scores were 0.4 for individuals with PWS and 0.7 for caregivers. CONCLUSIONS: Prader-Willi syndrome represents a major economic burden from a societal perspective and has a significant impact on health-related quality of life both for individuals suffering from PWS and for their caregivers in France. These results underscore the need to develop tailored policies targeted at improving care. Likewise, a larger study collecting a broader range of medical characteristics should be undertaken to achieve more precise estimations.

The impact of public versus private insurance on trauma patients.

BACKGROUND: The socioeconomic status has been associated with disparities in the incidence and mortality of traumatic injuries. However, there is a lack of studies on the level of health insurance with regard to various epidemiologic data of traumatic injuries, which this study opted to clarify. MATERIALS AND METHODS: All consecutive 6595 patients admitted to a level one trauma center in 2012 and 2013 were included in this retrospective cohort study. Patients were grouped according to their health insurance status (public versus private extended health care insurance) and compared with regard to several epidemiologic variables, that is, the type of injuries, inhospital outcome, and surgical procedures. RESULTS: Public insurance coverage was significantly more common than private insurance (75% versus 25%). Public insurance was associated with younger age, male sex, transfers to another hospital or mental institution, head concussions, head fractures, and increased mortality. Contrarily, patients with private insurance were more often associated with longer hospital stay, discharge to a rehabilitation clinic, fractures of the proximal humerus, and shoulder dislocations. However, there were no significant differences for the remaining majority of studied variables. CONCLUSIONS: In a trauma setting, the level of insurance does not seem to play a crucial role in most types of injuries and surgical procedures in a country with a high level of obligatory health care coverage. Nonetheless, it appears that publicly insured patients are more commonly younger, males, transferred to another hospital more often, more prone to head trauma, and subject to increased mortality, whereas privately insured patients show longer hospital stays, increased transfers to rehabilitation clinics, and more fractures of the proximal humerus.

Editor's choice - thirty day outcomes and costs of fenestrated and branched stent grafts versus open repair for complex aortic aneurysms.

OBJECTIVE: To compare 30 day outcomes and costs of fenestrated and branched stent grafts (f/b EVAR) and open surgery (OSR) for the treatment of complex abdominal aortic aneurysms (AAA) and thoraco-abdominal aortic aneurysms (TAAA). METHODS: The multicenter prospective registry WINDOW was set up to evaluate f/b EVAR in high risk patients with para/juxtarenal AAA, and infradiaphragmatic and supradiaphragmatic TAAA. A control group of patients treated by OSR was extracted from the national hospital discharge database. The primary endpoint was 30 day mortality. Secondary endpoints included severe complications, length of stay, and costs. Mortality was assessed by survival analysis and uni/multivariate Cox regression analyses using pre- and post-operative characteristics. Bootstrap methods were used to estimate the cost-effectiveness of f/b EVAR versus OSR. RESULTS: Two hundred and sixty eight cases and 1,678 controls were included. There was no difference in 30 day mortality (6.7% vs. 5.4%, p = 0.40), but costs were higher with f/b EVAR (€38,212 vs. €16,497, p < .001). After group stratification, mortality was similar with both treatments for para/juxtarenal AAA (4.3% vs. 5.8%, p = .26) and supradiaphragmatic TAAA (11.9% vs. 19.7%, p = .70), and higher with f/b EVAR for infradiaphragmatic TAAA (11.9% vs. 4.0%, p = .010). Costs were higher with f/b EVAR for para/juxtarenal AAA (€34,425 vs. €14,907, p < .0001) and infradiaphragmatic TAAA (€37,927 vs. €17,530, p < .0001), but not different for supradiaphragmatic TAAA (€54,710 vs. €44,163, p = .18). CONCLUSION: f/b EVAR does not appear justified for patients with para/juxtarenal AAA and infradiaphragmatic TAAA fit for OSR but may be an attractive option for patients with para/juxtarenal AAA not eligible for surgery and patients with supradiaphragmatic TAAA. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov/ct2/show/NCT01168037; identifier: NCT01168037 (WINDOW registry).

Assessment of the shear acoustic velocities in the different materials composing a high frequency solidly mounted resonator.

Thin film acoustic resonators operating in the shear mode are being increasingly used for in-liquid sensing applications. A good design of such sensors requires accurate knowledge of the acoustic properties of the materials composing the whole device, which specifically includes their shear velocities. Here we present a method to assess the shear acoustic velocity of high and low acoustic impedance films commonly used in AlN-based solidly mounted resonators (SMRs), using test devices specifically designed to induce a half-wavelength resonance in the layer under study. Provided that the thickness and mass densities of all the layers are known, fitting the electrical response by Mason's model over a wide frequency range gives accurate values of both longitudinal and shear mode velocities. The assessment of porous and dense SiO2, Mo, W and Ta2O5 sputtered films yields shear velocities of 3150m/s, 3950m/s, 3450m/s, 3350m/s and 2900m/s, respectively. In addition, the resonances stimulated in the Ir and Au top electrodes enable deriving their shear modes velocities, with values of 3950m/s and 2350m/s, respectively.

[Neonatal screening of severe combined immunodeficiencies]. / Projet de mise en place du dépistage néonatal systématique des déficits immunitaires combinés sévères : présentation de l'étude DEPISTREC.

Severe combined immunodeficiencies (SCID) are a group of inherited diseases of the immune system characterized by profound abnormalities of T-cell development. Infants with SCID require prompt clinical intervention to prevent life-threatening infection and studies show significantly improved survival in babies diagnosed at birth based on previous family history. SCID follows the criteria for population-based newborn screening because it is asymptomatic at birth and fatal within the 1st year of life if there is no intervention, the confirmation of the disease is easy, there is a curative treatment, and it is known that early hematopoietic stem cell transplantation significantly improves survival, the quality of immune reconstitution, and quality of life. Quantification of T-cell receptor excision circles (TRECs) in DNA extracted from Guthrie samples is a sensitive and specific screening test for SCID. We conducted a nationwide prospective study of neonatal screening of SCID in a population of 200,000 French newborns over a period of 2 years. The objective was to study the clinical utility and the cost-effectiveness ratio, and to demonstrate that universal SCID screening could result in a substantial benefit to detect individuals, making screening relatively cost-effective in spite of the low incidence of the disease.

Current application of National Institute for Health and Clinical Excellence (NICE) guidance in the management of patients with severe psoriasis: a clinical audit against NICE guidance in seven National Health Service specialist dermatology units in England.

BACKGROUND: Psoriasis affects 1-2% of the U.K. population, with 20-30% of those affected having severe psoriasis managed with systemic therapies. Biological agents are a useful option when other systemic therapies have failed. The National Institute for Health and Clinical Excellence (NICE) in the U.K. has published three sets of guidance relating to the use of biological agents. AIM: To establish whether biological agents were being used in line with NICE guidance. METHODS: The study was conducted in seven specialist dermatology units, and involved the retrospective collection of data from patients treated with biological agents since the introduction of the NICE guidance. RESULTS: In total, 176 patients with 212 episodes of treatment were included in the study. Biologics were started for appropriately severe disease in 85% of cases (n = 180) and only after failure, intolerance or contraindication to standard systemic therapies in 97% of cases (n = 206). Etanercept was discontinued appropriately in responders before week 24 in only 12% (five of 60 responders). Across all agents, 40% (72 of 178 with continuity status) were continued on treatment despite not achieving an adequate response according to NICE criteria. CONCLUSIONS: In the seven sites audited, compliance with national guidance was entirely appropriate in terms of therapy initiation; however, the requirement to discontinue etanercept in responders was rarely followed. Similarly, discontinuation of biologicals in nonresponders was not routine practice. This may indicate a reluctance of both patients and clinicians to withdraw an at least partly effective therapy from these refractory patients.

[Adoption of health promotion behaviors in first-year baccalaureate nursing students: pilot study]. / Comportements de promotion de la santé d'étudiantes de première année au baccalauréat en sciences infirmières: etude pilote.

The goal of this pilot study was to test the usefulness of Pender's (1987) theoretical model in predicting the adoption of health-promotion behaviours in 176 first-year undergraduate nursing students. Hierarchical regression analysis indicated that the perception of self-efficacy, perception of one's state of health, the influence of professors, and place of birth are predictive variables of health-promoting behaviours in this group. The results of this study suggest, among other things, that it is important for professors to use strategies that foster and support students' confidence in their ability to commit to health-promoting behaviours. A longitudinal study currently in progress will examine whether a health-oriented program significantly influences the adoption of health-promotion behaviours in nursing students during their university education.

[Experimental intravascular pressure-volume measurement for assessment of the biomechanical load tolerance of microvascular anastomoses]. / Experimentelle intravasale Druck-Volumen-Messung zur Beurteilung der biomechanischen Belastbarkeit mikrovaskulärer Anastomosen.

To investigate the tolerance of microvascular anastomoses to a mechanical load, we performed experimental intravascular pressure-volume measurements on the abdominal aorta and the renal vein in the rat. In one group the vessels were sectioned and repaired with interrupted sutures, while in the control group no surgical intervention was performed. The pressure studies were all undertaken on the 14th post-operative day. All operated vessels showed a distinct decrease in elasticity. High intravascular pressure was reached with little injection volume, but there was no difference between the two groups with respect to the pressure at which leakage occurred. Leaks were located between the single sutures. In no case was a complete disruption observed at the anastomotic site. Consequently, the strength of microvascular anastomoses depends mostly on the suture material. In the experiments the suture material, the number of interrupted sutures and their thickness did not differ from those used in clinical application. This suggests that on the 14th postoperative day microvascular anastomoses on human vessels are of the same strength as demonstrated by our experimental anastomoses. In our opinion therefore reoperation at the anastomotic site or well controlled physical therapy can be tolerated in the clinical case without any risk of anastomotic disruption at least by the 14th postoperative day.